Anterior vaginal wall repair

Vaginal wall repair; Colporrhaphy - repair of vaginal wall; Cystocele repair - vaginal wall repair

Anterior vaginal wall repair is a surgical procedure. This surgery tightens the front (anterior) wall of the vagina.

Description

The anterior vaginal wall can sink (prolapse) or bulge. This occurs when the bladder or the urethra sink into the vagina.

The repair may be done while you are under:

General anesthesia: You will be asleep and unable to feel pain.
General anesthesia
General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive the...

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Spinal anesthesia: You will be awake, but you will be numb from the waist down and you will not feel pain. You will be given medicines to help you relax.
Spinal anesthesia
Spinal and epidural anesthesia are procedures that deliver medicines that numb parts of your body to block pain. They are given through shots in or ...

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Your surgeon will:

Make a surgical cut through the front wall of your vagina.
Vagina
The vagina is the female body part that connects the womb (uterus) and cervix to the outside of the body.
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Move your bladder back to its normal location.
May fold your vagina, or cut away part of it.
Put sutures (stitches) in the tissue between your vagina and bladder. These will hold the walls of your vagina in the correct position.
Place a patch between your bladder and vagina. This patch can be made of commercially available biological material (cadaveric tissue). The FDA has banned use of synthetic material and animal tissue in the vagina to treat anterior vaginal wall prolapse.
Attach sutures to the walls of the vagina to the tissue on the side of your pelvis.

Why the Procedure Is Performed

This procedure is used to repair sinking or bulging of the anterior vaginal wall.

Symptoms of anterior vaginal wall prolapse include:

You may not be able to empty your bladder completely.
Your bladder may feel full all the time.
You may feel pressure in your vagina.
You may be able to feel or see a bulging at the opening of the vagina.
You may have pain when you have sex.
You may leak urine when you cough, sneeze, or lift something.
You may get bladder infections.

This surgery by itself does not treat stress incontinence. Stress incontinence is the leaking of urine when you cough, sneeze, or lift. Surgery to correct stress urinary incontinence may be performed along with other surgeries.

Before doing this surgery, your health care provider may have you:

Learn pelvic floor muscle exercises (Kegel exercises)
Kegel exercises
Kegel exercises can help make the muscles under the uterus, bladder, and bowel (large intestine) stronger. They can help both men and women who have...

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Use estrogen cream in your vagina
Try a device called a pessary in your vagina to strengthen the muscle around the vagina

Risks

Risks for anesthesia and surgery in general are:

Reactions to medicines
Breathing problems
Bleeding, blood clots
Infection

Risks for this procedure include:

Damage to the urethra, bladder, or vagina
Irritable bladder
Changes in the vagina (prolapsed vagina)
Urine leakage from the vagina or to the skin (fistula)
Worsening urinary incontinence
Urinary incontinence
Urinary (or bladder) incontinence occurs when you are not able to keep urine from leaking out of your urethra. The urethra is the tube that carries ...
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Lasting pain
Complications from the material used during surgery (mesh/grafts)

Before the Procedure

Always tell your surgeon what medicines you are taking. Also tell them about the medicines, supplements, or herbs you bought without a prescription that you are taking.

During the days before the surgery:

You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
Ask your surgeon which medicines you should still take on the day of your surgery.

On the day of your surgery:

You very often will be asked not to drink or eat anything for 6 to 12 hours before the surgery.
Take the medicines your surgeon told you to take with a small sip of water.
Your surgeon will tell you when to arrive at the hospital.

After the Procedure

You may have a catheter to drain urine for 1 or 2 days after surgery. You can start eating normal food soon after the surgery.

When your normal bowel function returns, you can return to your regular diet.

You should not insert anything in the vagina, lift heavy items, or have sex until your surgeon says it is OK.

Outlook (Prognosis)

This surgery will very often repair the prolapse and the symptoms will go away. This improvement will often last for years.

Open References

References

Kirby AC, Lentz GM. Pelvic organ prolapse, abdominal hernias, and inguinal hernias: diagnosis and management. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 20.

Winters JC, Krlin RM, Hallner B. Vaginal and abdominal reconstructive surgery for pelvic organ prolapse. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 124.

Wolff GF, Winters JC, Krlin RM. Anterior pelvic organ prolapse repair. In: Smith JA Jr, Howards SS, Preminger GM, Dmochowski RR, eds. Hinman's Atlas of Urologic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 89.

Anterior vaginal wall repair - illustration
During anterior vaginal wall repair, the pubocervical fascia is folded and stitched to bring the bladder and urethra into the proper position.
Anterior vaginal wall repair
illustration
Cystocele - illustration
A cystocele is an downward outpocketing or hernia of the bladder towards the vaginal opening. The weakening of the muscular wall in this condition can cause urine to leak from the bladder when there is an increase in internal abdominal pressure such as in sneezing or coughing.
Cystocele
illustration
Anterior vaginal wall repair (surgical treatment of urinary incontinence) - series
Presentation

<strong>Anterior vaginal wall repair (surgical treatment of urinary incontinence) - series</strong><p>The vaginal opening lies just below the urethral opening, and just above the anal opening. The urethral opening, through which urine passes, leads to the bladder. The anus leads to the rectum. The vaginal opening leads to the vaginal canal, which leads to the uterus.</p>

<strong>Indications</strong><p>This procedure is used to repair the vaginal wall herniation that occurs with urethrocele, cystocele, or rectocele. This is occasionally performed to treat stress incontinence in women by supporting the bladder and urethra in its proper position, so it can function properly. As with most other surgical procedures, it is advised that you try medication and bladder retraining therapy first, before resorting to surgical treatment.</p>

<strong>Procedure, Part 1</strong><p>To perform the anterior vaginal repair, an incision is made through the vagina to release a portion of the anterior (front) vaginal wall that is attached to the base of the bladder. The bladder and urethra are then stitched into the proper position. There are several variations on this procedure that may be necessary based on the severity of the dysfunction. This procedure may be performed using general or spinal anesthesia. You may have a foley catheter in place for 1 to 2 days after surgery. You will be given a liquid diet immediately after surgery, followed by a low residue diet when your normal bowel function has returned. Stool softeners and laxatives may be prescribed to prevent straining with bowel movements since this can cause stress on the incision.</p>

<strong>Procedure, Part 2</strong><p>Women treated with this procedure have approximately a 60% rate of success in relieving symptoms. You should avoid activities that cause an increase in abdominal pressure, such as straining, sneezing, and coughing. Try to tighten your pelvic muscles when coughing or sneezing to support the bladder. You may need to urinate at least every 2 to 3 hours, or perform clean intermittent self catheterization (CISC), to keep your bladder from getting too full and putting pressure on the stitches. You should avoid any activities that require lifting or straining. You may need to take stool softeners or gentle laxatives to prevent constipation and straining with bowel movements.</p>

Anterior vaginal wall repair - illustration
During anterior vaginal wall repair, the pubocervical fascia is folded and stitched to bring the bladder and urethra into the proper position.
Anterior vaginal wall repair
illustration
Cystocele - illustration
A cystocele is an downward outpocketing or hernia of the bladder towards the vaginal opening. The weakening of the muscular wall in this condition can cause urine to leak from the bladder when there is an increase in internal abdominal pressure such as in sneezing or coughing.
Cystocele
illustration
Anterior vaginal wall repair (surgical treatment of urinary incontinence) - series
Presentation

A Closer Look

Self Care

Tests for Anterior vaginal wall repair

Review Date: 5/17/2024

Reviewed By: Sovrin M. Shah, MD, Associate Professor, Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Health Library

Anterior vaginal wall repair

Anterior

Description

General anesthesia

Spinal anesthesia

Vagina

Why the Procedure Is Performed

Anterior vaginal wall prolapse

Stress incontinence

Kegel exercises

Risks

Urinary incontinence

Before the Procedure

After the Procedure

Catheter